Each year, as many as 50% of pregnant women experience depressive symptoms and about 11% develop antepartum depression (APD). It is well known that APD causes personal suffering, psychosocial and behavioral risks, and adverse birth outcomes, particularly among rural, minority, and low-income women. It is also known that there is an interaction between psychosocial risk, personal resources, and depression. It is critical to develop culturally relevant and sustainable models for treatment that are tailored to rural and minority low-income women at risk for APD and delivered within prenatal clinics, including the local health department (LHD). Models such as these could reduce the significant burden of antepartum depression and the sequelae, consequences, and complications. We propose to assess the feasibility, fidelity, acceptability, and preliminary treatment outcomes of Insight-Plus (IP), a culturally tailored and technology enhanced cognitive behavioral intervention (CBI), delivered by a social worker (LCSW) and a resource mom (RM) lay health person, in a local health department (LHD) and affiliated prenatal clinic. This pilot randomized controlled trial will compare antepartum depressive symptoms in women in the IP-CBI to women in a treatment-as-usual (TAU) group (n=124).We will also explore the association of potential mediators (stress, negative thoughts, self esteem, and social support) and moderators (ethnicity/race and parity) on antepartum depressive symptoms (APDS). This purpose is consistent with the mission of NIMH and has a high level of congruence with the purpose of this R34 mechanism, which is to evaluate novel approaches to improving mental health and modifying health risk behaviors, and obtaining preliminary data that can lead to an R01 level randomized clinical trial. Findings from this study will also be highly relevant for public health because the IP-CBI is integrated within rural prenatal clinics, including the local health department (LHD), where access to mental health resources for treating and preventing antepartum depression are limited. Our specific aims are to: (1) evaluate the feasibility and treatment fidelity of a social worker (LCSW) and a resource mom (RM) delivering Insight-Plus CBI (IP-CBI) in a local health department (LHD) and affiliated prenatal clinic; (2) evaluate if the IP- CBI intervention delivered by a social worker and a resource mom (RM) minimizes the progression of depressive symptoms in women with moderate symptoms for APD, or reduces depressive symptoms in women at high risk for APD; (3) Explore the association of potential mediators (stress, negative thoughts, self esteem, and social support) and moderators (ethnicity/race and parity) on depressive symptoms; (4) Evaluate the acceptability of Insight-Plus CBI (IP-CBI) delivered by a social worker and a resource mom (RM) in a local health department (LHD) setting. Should the intervention prove to be feasible and effective, it will be a model for delivering care by public health staff and lay helpers and a model for care for low-income women nationally. PUBLIC HEALTH RELEVANCE: Findings from this study will be highly relevant for public health because the IP-CBI is integrated within rural prenatal clinics, including the local health department (LHD), where access to mental health resources for treating and preventing antepartum depression are limited. In addition, the intervention is sensitive to the cultural needs of low-income African-American, Caucasian, and Hispanic women, a population that has been underrepresented in previous studies.